ROBERT E. STRZELCZYK, BS, and LAUREN A. HEBERT, BS Key Words: Administrative personnel, Communication, Group practice, Job satisfac tion, Peer review, Personnel management.
A growing trend in rehabilitation services is the therapy group practice. Such a therapy provider can meet the manpower needs of shortage areas such as rural hospitals and convalescent settings. The advan tages to the client facility are availability of manpower and equipment and provision of quality patient care. Such group practices also offer therapists a unique opportunity to hold challenging multirole positions in small departments but with certain advantages of a large group practice. A large group practice may, however, present cer tain unique problems for staff therapists. An agency may employ a large number of therapists, but they are usually dispersed over a wide geographic area and work in small departments. The advantage of guided independence may be overshadowed by a lack of peer contact and communication. This can lead to frustra tion and a feeling of abandonment. The result is often dissatisfaction, costly staff turnover, and eventually a breakdown in quality patient care. Private practice groups owe it to their staff, client facilities, and pa tients to provide effective staff supervision and peer contact. This need is also an important concern in the minds of both the experienced therapists in group practice and the educators sending forth new gradu ates into the profession. Our agency was quite successful in identifying these problems and implementing a program to meet these special needs of our staff. We provide physical ther apy, occupational therapy, and speech pathology ser vices to various types of health care facilities in Wisconsin and Minnesota, and our practice has grown very rapidly. In 1977, for example, we gained
Mr. Strzelczyk is President and Coordinator of Rehabilitation Services for Therapy Associates, Inc, 1516 W Mequon Rd, Mequon, WI 53092. Mr. Hebert was Chief Physical Therapist and Assistant Coordi nator of Rehabilitation Services for Therapy Associates, Inc, when this article was written. He is now Chief Physical Therapist, Depart ment of Physical Therapy, Penobscot Bay Medical Center, Glen Cove, Rockland, ME 04841. Address reprint requests to Mr. Hebert. This article was submitted October 4, 1977, and accepted December 7, 1978.
Volume 59 / Number 7, July 1979
Downloaded from https://academic.oup.com/ptj/article-abstract/59/7/875/4559605 by University of Texas at Dallas - McDermott Library user on 08 February 2019
Building Peer Contact Within a Group Practice
10 new departments and 41 percent more patient care requests in the physical therapy program alone. To prevent any problems with communication or super vision, we sought to provide staff with a balance between the rewards of operating a small department and the advantage of functioning within a large, broad-based group of professionals. A program stressing peer contact and supervisory contact evolved to deal with maintaining a strong sense of community within the agency. This called for such "luxury" mechanisms as traveling for super visors, open telephone communications, and peerreview processes. These internal staff-support and quality-assurance mechanisms are very costly. Ad ministration believed, however, that maintaining the priority of quality patient care and staff satisfaction would adequately carry over to the financial and business needs of the practice. The procedures in clude: 1. Supervisor visits. Face-to-face, individualized contact between staff therapists and supervisors is extremely valuable. These supervisors represent ad ministration to staff as well as staff to administration. These department visits must be regular and frequent. Our experience has demonstrated that visits every two to three weeks by each discipline's supervisor are optimal. These visits serve to transmit and clarify communications, assure proper execution of policy and procedures, assist in problem solving, and per form quality-assurance audits. Regular visits by a coordinator of rehabilitation tie together the three primary disciplines of physical therapy, occupational therapy, and speech pathology. 2. WATS lines. By having two-way WATS lines connecting each facility with the central office, we can provide immediate attention to problems as they arise. An instantly available line of communication is essential for smooth operation of a large practice, facilitating consultation and supervisory input. 3. Peer-review audits. A problem-oriented system functions at its best when audit feedback is provided. This feedback allows staff to share concepts and 875
THE BEGINNINGS: Physical Therapy and the APTA
meetings within individual facilities are encouraged to coordinate patient goals. Area meetings of geo graphically clustered staff of the individual disciplines are held every four to six months for program devel opment and peer contact. 7. Senior staff. We are currently experimenting with the concept of a senior staff level person. The roles of these staff members vary with the individual needs of each geographic area but usually include coordinating local staffing patterns during vacations or work-load shifts and providing extra peer contact for new staff, especially new graduates. The procedures of "area meetings" and use of "senior staff' are implemented to varying degrees by the three primary disciplines to fit individual needs, but peer contact is emphasized throughout the agency. These procedures are costly, but when properly implemented, they have proven themselves effective at keeping communications open and staff satisfac tion high. Physical therapy staff turnover, for exam ple, has decreased from 35 percent in the 1976-1977 fiscal year to 8 percent in 1977-1978. We are seeing excellent growth in staff performance and program sophistication, which in turn is drawing many new inquiries about our services. Staff satisfaction and pride facilitates motivation of personnel and quality patient care, which provides for a sound business. Private practice managers have a responsibility to their practice, their staff, and the profession to meet the special needs of staff located in outlying depart ments.
Traces the growth and development of physical therapy as inextricably woven into the growth of the present-day American Physical Therapy Association through articles and photographs from early issues of the Physiotherapy Review (1921, onward).
Paperback, $5.50 Order from the American Physical Therapy Association, 7756 15th St NW, Washington, DC 20005. Checks made payable to APTA.
876
PHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/59/7/875/4559605 by University of Texas at Dallas - McDermott Library user on 08 February 2019
treatment approaches as well as optimizes the effi ciency of the record system. During each supervisory visit and contact with nearby fellow staff, one or two records are audited according to a defined problemoriented medical record format for the behaviors of completeness, reliability, efficiency, and sound clini cal judgment. Follow-up consultation assures educa tional feedback for both the auditor and those au dited. 4. Staff newsletter. A newsletter to all staff creates a sense of community within the agency. New staff and client facilities are introduced, explanations of new legislation and regulations are offered, sugges tions are shared, and credit and encouragement is given for program development and special accom plishments. 5. Competency directory. A listing of special areas of high competency of individual staff members fa cilitates effective consultation for solving difficult patient care problems. Therapists are encouraged to contact the sources of special skills by using the WATS lines and talking to the visiting supervisors. 6. Staff meetings. The entire agency staff meets at least once a year for a day-long series of seminars. The day usually consists of personal contact among staff, a general information meeting, an individual discipline meeting for program development issues, and guest lectures for inservice training. Such an overall shutdown amounts to many thousands of dollars in nonproductive salary costs but justifies itself in boosting staff morale and generating new ideas. Smaller, more frequent (at least once a month) staff
A growing trend in rehabilitation services is the therapy group practice. Such a therapy provider can meet the manpower needs of shortage areas such as rural hospitals and convalescent settings. The advan tages to the client facility are availability of manpower and equipment and provision of quality patient care. Such group practices also offer therapists a unique opportunity to hold challenging multirole positions in small departments but with certain advantages of a large group practice. A large group practice may, however, present cer tain unique problems for staff therapists. An agency may employ a large number of therapists, but they are usually dispersed over a wide geographic area and work in small departments. The advantage of guided independence may be overshadowed by a lack of peer contact and communication. This can lead to frustra tion and a feeling of abandonment. The result is often dissatisfaction, costly staff turnover, and eventually a breakdown in quality patient care. Private practice groups owe it to their staff, client facilities, and pa tients to provide effective staff supervision and peer contact. This need is also an important concern in the minds of both the experienced therapists in group practice and the educators sending forth new gradu ates into the profession. Our agency was quite successful in identifying these problems and implementing a program to meet these special needs of our staff. We provide physical ther apy, occupational therapy, and speech pathology ser vices to various types of health care facilities in Wisconsin and Minnesota, and our practice has grown very rapidly. In 1977, for example, we gained
Mr. Strzelczyk is President and Coordinator of Rehabilitation Services for Therapy Associates, Inc, 1516 W Mequon Rd, Mequon, WI 53092. Mr. Hebert was Chief Physical Therapist and Assistant Coordi nator of Rehabilitation Services for Therapy Associates, Inc, when this article was written. He is now Chief Physical Therapist, Depart ment of Physical Therapy, Penobscot Bay Medical Center, Glen Cove, Rockland, ME 04841. Address reprint requests to Mr. Hebert. This article was submitted October 4, 1977, and accepted December 7, 1978.
Volume 59 / Number 7, July 1979
Downloaded from https://academic.oup.com/ptj/article-abstract/59/7/875/4559605 by University of Texas at Dallas - McDermott Library user on 08 February 2019
Building Peer Contact Within a Group Practice
10 new departments and 41 percent more patient care requests in the physical therapy program alone. To prevent any problems with communication or super vision, we sought to provide staff with a balance between the rewards of operating a small department and the advantage of functioning within a large, broad-based group of professionals. A program stressing peer contact and supervisory contact evolved to deal with maintaining a strong sense of community within the agency. This called for such "luxury" mechanisms as traveling for super visors, open telephone communications, and peerreview processes. These internal staff-support and quality-assurance mechanisms are very costly. Ad ministration believed, however, that maintaining the priority of quality patient care and staff satisfaction would adequately carry over to the financial and business needs of the practice. The procedures in clude: 1. Supervisor visits. Face-to-face, individualized contact between staff therapists and supervisors is extremely valuable. These supervisors represent ad ministration to staff as well as staff to administration. These department visits must be regular and frequent. Our experience has demonstrated that visits every two to three weeks by each discipline's supervisor are optimal. These visits serve to transmit and clarify communications, assure proper execution of policy and procedures, assist in problem solving, and per form quality-assurance audits. Regular visits by a coordinator of rehabilitation tie together the three primary disciplines of physical therapy, occupational therapy, and speech pathology. 2. WATS lines. By having two-way WATS lines connecting each facility with the central office, we can provide immediate attention to problems as they arise. An instantly available line of communication is essential for smooth operation of a large practice, facilitating consultation and supervisory input. 3. Peer-review audits. A problem-oriented system functions at its best when audit feedback is provided. This feedback allows staff to share concepts and 875
THE BEGINNINGS: Physical Therapy and the APTA
meetings within individual facilities are encouraged to coordinate patient goals. Area meetings of geo graphically clustered staff of the individual disciplines are held every four to six months for program devel opment and peer contact. 7. Senior staff. We are currently experimenting with the concept of a senior staff level person. The roles of these staff members vary with the individual needs of each geographic area but usually include coordinating local staffing patterns during vacations or work-load shifts and providing extra peer contact for new staff, especially new graduates. The procedures of "area meetings" and use of "senior staff' are implemented to varying degrees by the three primary disciplines to fit individual needs, but peer contact is emphasized throughout the agency. These procedures are costly, but when properly implemented, they have proven themselves effective at keeping communications open and staff satisfac tion high. Physical therapy staff turnover, for exam ple, has decreased from 35 percent in the 1976-1977 fiscal year to 8 percent in 1977-1978. We are seeing excellent growth in staff performance and program sophistication, which in turn is drawing many new inquiries about our services. Staff satisfaction and pride facilitates motivation of personnel and quality patient care, which provides for a sound business. Private practice managers have a responsibility to their practice, their staff, and the profession to meet the special needs of staff located in outlying depart ments.
Traces the growth and development of physical therapy as inextricably woven into the growth of the present-day American Physical Therapy Association through articles and photographs from early issues of the Physiotherapy Review (1921, onward).
Paperback, $5.50 Order from the American Physical Therapy Association, 7756 15th St NW, Washington, DC 20005. Checks made payable to APTA.
876
PHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/59/7/875/4559605 by University of Texas at Dallas - McDermott Library user on 08 February 2019
treatment approaches as well as optimizes the effi ciency of the record system. During each supervisory visit and contact with nearby fellow staff, one or two records are audited according to a defined problemoriented medical record format for the behaviors of completeness, reliability, efficiency, and sound clini cal judgment. Follow-up consultation assures educa tional feedback for both the auditor and those au dited. 4. Staff newsletter. A newsletter to all staff creates a sense of community within the agency. New staff and client facilities are introduced, explanations of new legislation and regulations are offered, sugges tions are shared, and credit and encouragement is given for program development and special accom plishments. 5. Competency directory. A listing of special areas of high competency of individual staff members fa cilitates effective consultation for solving difficult patient care problems. Therapists are encouraged to contact the sources of special skills by using the WATS lines and talking to the visiting supervisors. 6. Staff meetings. The entire agency staff meets at least once a year for a day-long series of seminars. The day usually consists of personal contact among staff, a general information meeting, an individual discipline meeting for program development issues, and guest lectures for inservice training. Such an overall shutdown amounts to many thousands of dollars in nonproductive salary costs but justifies itself in boosting staff morale and generating new ideas. Smaller, more frequent (at least once a month) staff
